Healthcare Provider Details

I. General information

NPI: 1740346246
Provider Name (Legal Business Name): MARK WALKER MS, LMHC, LPC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 E 39TH ST
VANCOUVER WA
98663-2233
US

IV. Provider business mailing address

PO BOX 1845
VANCOUVER WA
98668-1845
US

V. Phone/Fax

Practice location:
  • Phone: 360-546-1722
  • Fax: 360-694-5372
Mailing address:
  • Phone: 360-546-1722
  • Fax: 360-694-5372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61155224
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-476
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: